Intervertebral implant

ABSTRACT

An intervertebral implant comprises first and second parts having outer surfaces engaging adjacent vertebral surfaces. An insert between these parts provides relative movement therebetween. The first and/or second parts may have engagement means in the form of apertures for engagement with insertion instruments. The first and second parts may nest together, in the absence of the insert, for insertion into the intervertebral space. The boundaries of the implant may form a working space which would include insertion instruments therein. A detent and detent recess may be provided for engagement of the insert and one of said first and second parts.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 10/018,402, filed on Jun. 12, 2002, now U.S. Pat. No. 6,936,071; which is the national stage entry of International Patent Application No. PCT/EP99/04628, filed on Jul. 2, 1999. The entire disclosure of U.S. Pat. No. 6,936,071 and International Patent Application No. PCT/EP2009/04628 are incorporated herein by reference.

BACKGROUND OF THE INVENTION

The invention relates to an intervertebral implant, having an upper part that has a support face for a vertebra and a lower part that has a support face for an adjacent vertebra, on each of which parts engagement elements, which are accessible from one side of the intervertebral implant, for a manipulation instrument are disposed, in order to minimize the structural height of the intervertebral implant upon insertion into an intervertebral space.

One such intervertebral implant is known for instance from U.S. Pat. No. 5,314,477. This intervertebral implant is used to replace a disk removed from the intervertebral space, and accordingly the intervertebral implant must have a relatively low structural height, since it has to fit into the gap between vertebrae. This is particularly difficult if an additional pivot insert is also embedded between the upper part and the lower part, as is the case in the known intervertebral implant of U.S. Pat. No. 5,314,477.

But even in two-piece intervertebral implants, difficulties also arise, especially if the implants also have pins and other protrusions on their support faces that are intended for anchoring the intervertebral implant in the bone. Often, these parts can be inserted only by widening the intervertebral space greatly. Not only is this difficult, but it also presents the risk of injuries.

Since the intervertebral space has a relatively low height, it is also difficult for engagement elements that a manipulation instrument can engage to be secured to both parts of the intervertebral implant. It is conventional to have such manipulation instruments engage the upper part and the lower part separately, for instance by means of pins that are inserted into bores on the upper part and lower part, so that with the manipulation instrument, the two parts of the intervertebral implant can be inserted into the intervertebral space and can optionally also be varied in terms of their spacing from one another, thereby allowing a certain spreading open of the intervertebral space. In this respect, reference is made to the pincerlike manipulation instrument of U.S. Pat. No. 5,314,477.

Because of the strong forces, it is necessary to provide a certain structural height for the engagement elements; for instance, the receiving bores must have a certain diameter. This dictates a minimum structural height for the upper part and for the lower part, and in conventional intervertebral implants, the structural heights of the upper part and lower part are thus added together, so that even if the upper and lower parts rest directly on one another, a relatively great structural height of the intervertebral implant is still unavoidable.

SUMMARY OF THE INVENTION

It is the object of the invention to embody an intervertebral implant of this generic type in such a way that the minimum structural height is reduced, to make it easier to insert the intervertebral implant into the intervertebral space.

In an intervertebral implant of the type described at the outset, this object is attained in accordance with the invention in that it is proposed that the upper part and lower part each have protrusions and recesses aimed at the respectively other part, which are offset laterally from one another in such a way that when the upper part has been brought close to the lower part they mesh with one another; and that the engagement elements on the upper part and on the lower part are each disposed in protrusions of these parts in such a way that the engagement elements of the upper part and lower part are located side by side and at least partly overlap in the direction of the height of the intervertebral implant.

In such an embodiment, a minimal structural height of the two intervertebral implant parts resting on one another can be attained, since the engagement elements, which cannot fall below a minimal structural height, are each disposed in protrusions of the upper part and lower part, or in other words in the parts of the upper part and lower part that have the greatest structural height. These regions of great structural height are embodied as protrusions, next to which are respective recesses, into which the protrusions of the respectively other part can dip. As a result, on the one hand, the engagement elements for the manipulation instruments are located side by side, and on the other, they can at least partly overlap, so that the total structural height of the parts resting on one another of the intervertebral implant can be reduced markedly compared to conventional intervertebral implants. The result is accordingly an internested arrangement of the upper and lower parts, with maximal exploitation of the available material height.

It is favorable if the engagement elements are insertion openings for pinlike retaining elements of a manipulation instrument; because of the described construction, these insertion openings can have a relatively large diameter and can thus receive strong retaining pins, and nevertheless a relatively low structural height of the intervertebral implant with parts resting directly on one another is obtained.

It is advantageous if the insertion openings extend substantially parallel to the support faces; once again, this prevents an increase in the structural height of the intervertebral implant parts.

In a preferred embodiment, it is provided that the lower part has a central indentation, opposite the lower support face, which indentation is surrounded by a U-shaped edge. Thus with the lower part and upper part resting directly on one another, the indentation serves to receive a protrusion on the upper part.

It is advantageous if the upper part has a central protrusion that fits substantially in complimentary fashion into the indentation; that is, the total volume of the indentation is utilized for the protrusion.

It is also advantageous if the engagement elements of the lower part are disposed on the two ends of the U-shaped edge, or in other words are located on the outside.

Conversely, the engagement elements of the upper part can be disposed on the central protrusion of the upper part, or in other words are located farther inward than the engagement elements of the upper part.

In particular, the engagement elements of the upper part can be disposed near the lateral edges of the central protrusion, so that for the upper part as well, the spacing of the engagement elements can be selected to be relatively great; as a result, both the upper part and the lower part can be reliably secured against skewing.

It should already be noted here that the words “lower part” and “upper part” do not necessarily say anything about the installed position of the intervertebral implant in the spinal column; the part called the “lower part” could in fact be above in the spinal column. Therefore, these parts may also be referred to as first and second parts having outer and inner surfaces. What is essential is merely that the upper part and lower part define the intervertebral implant on opposite sides of the implant.

It is especially advantageous if the upper part and/or the lower part is embodied in substantially platelike fashion; these parts naturally, in accordance with the design of the invention, have protrusions and recesses that are oriented toward the respectively other part. The platelike embodiment, however, leads as a whole to a very low structural height of the intervertebral implant.

In a preferred embodiment, the lower part and the upper part each have a respective receptacle for a pivot insert. This pivot insert, which is placed between the upper part and lower part after the insertion of the intervertebral implant, supports the upper part and lower part against one another; it takes on a resilient function, for instance, and furthermore leads to a certain pivotability of the two parts of an intervertebral implant relative to one another, so that a pivotability of the adjacent vertebra is thus attainable as well.

In particular, it is advantageous if the pivot insert has at least one spherical support face, which engages the correspondingly spherically shaped receptacle.

It is favorable if the spherical receptacle is disposed in the central protrusion of the upper part.

It is also advantageous if the central indentation of the lower part forms the receptacle for the pivot insert.

According to a preferred embodiment of the invention, it is provided that the pivot insert can be inserted from the side into the receptacle, which has the engagement elements for a manipulation instrument. This is the side from which the upper part and lower part are introduced into the intervertebral space, and it is also from this side that the pivot insert can then be thrust between the already-inserted parts of the intervertebral implant.

It is favorable if the pivot insert is insertable into the receptacle along a guide.

In that the insert as well is preferably embodied substantially in platelike fashion.

An especially favorable design is obtained if the insert substantially completely fills up the central receptacle and with its spherical support face protrudes from the receptacle.

BRIEF DESCRIPTION OF THE DRAWINGS

The ensuing description of preferred embodiments of the invention serves in conjunction with the drawing to provide further explanation. Shown are:

FIG. 1: a perspective exploded view of an intervertebral implant with an upper part, a lower part, and a pivot insert that can be inserted between them;

FIG. 2: a perspective exploded view of the upper part and the lower part of the intervertebral implant, without an inserted pivot insert;

FIG. 3: a view similar to FIG. 2 with the pivot insert inserted into the lower part;

FIG. 4: a perspective view of the upper part and the lower part of the intervertebral implant with maximum mutual proximity;

FIG. 5: a front view of the intervertebral implant of FIG. 4;

FIG. 6: a perspective view of the intervertebral implant with the pivot insert inserted; and

FIG. 7: a cross-sectional view of the intervertebral implant of FIG. 6.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The intervertebral implant 1 shown in the drawing includes three parts, namely a platelike upper part 2, a platelike lower part 3, and a substantially platelike pivot insert 4.

The upper part 2 is embodied flat on its top, thus creating a support face 5, on which various kinds of protrusions 6, 7 are disposed which serve the purpose of anchoring the upper part 2 in a vertebra that rests, with its end face toward an intervertebral space, on the support face 5.

The upper part 2 is substantially rectangular in cross section; in the exemplary embodiment shown, a longitudinal edge 8 curves outward.

On the two short sides of this rectangle, the thickness of the platelike upper part 2 is less than in the central region, so that along the short sides of the upper part 2, downward-pointing recesses 9 each extending parallel to these edges are formed that are open toward the outside. The central region of the upper part 2 is located between the two recesses 9 and thus has a greater thickness or height and thus forms a downward-pointing protrusion 10 embodied between the two recesses 9. This protrusion is defined by an underside 11, which extends substantially parallel to the support face 5 and in which there is a spherical indentation 12, which forms a bearing plate for the pivot insert 4.

The lower part 3 of the intervertebral implant 1 is also platelike in embodiment and on its underside has a flat support face 13 with protrusions 14 and 15, which correspond to the protrusions 6 and 7 of the support face 5. On the side remote from the support face 13, the thickness of the lower part 3 is less in the central region than in an outer region. This outer region of greater thickness has the form of a U, with two parallel legs 16, 17, which extend parallel to the short edges of the lower part 3, which in cross section is embodied similarly to the upper part 2, and with a crosspiece 18 that connects the two legs 16 and 17 on one end. The region enclosed by the legs 16 and 17 and the crosspiece 18 forms a central indentation 19, whose area is substantially equivalent to the area of the central protrusion 10 of the upper part 2, while the disposition and length of the legs 16 and 17 correspond essentially to the disposition and length of the recesses 9 on the upper part 2. As a result, it is possible to place the upper 2 and lower part 3 on one another in such a way that the central protrusion 10 of the upper 2 dips into the central indentation 19, while the legs 16 and 17 of the lower part 3 dip into the recesses 9 of the upper part 2 (FIG. 4); in this position, the upper part 2 and lower part 3 have maximum proximity to one another and a minimal structural height.

The dimensions are selected such that the various recesses are essentially filled completely by the protrusions dipping into them.

Blind bores 20 and 21 are machined into the two legs 16 and 17 of the lower part 3, extending parallel to these legs 16, 17 from their free ends; the diameter of these bores is relatively great in proportion to the height of the legs 16, 17, and this diameter is in fact greater than the thickness or height of the lower part 3 in the region of the central indentation 19.

Blind bores 22 and 23, which extend parallel to the blind bores 20 and 21 in the lower part 3, are machined into the central protrusion 10 of the upper part 2, in the vicinity of its side edges. These blind bores 22 and 23 again have a relatively great diameter, which corresponds to a substantial portion of the height of the protrusion 10 and is greater than the thickness of the upper part 2 in the region of the recesses 9.

When the upper part 2 and lower part 3 rest tightly against one another in the manner described, the blind bores 20 and 21 of the lower part 3 and the blind bores 22 and 23 of the upper part 2 overlap at least partly in the direction of the height of the intervertebral implant 1, as is clearly shown in FIGS. 4 and 5.

The blind bores 20, 21, 22 and 23 serve as receptacles for pinlike extensions of a manipulation instrument, not shown in the drawing, and thus form engagement elements for this manipulation instrument, which in this way separately engages the upper part 2 and the lower part 3. With this manipulation instrument, it is possible to introduce the upper part 2 and the lower part 3 of the intervertebral implant 1 into an intervertebral space; the very low structural height of the intervertebral implant 1 facilitates this introduction, which can be done essentially without major widening of the intervertebral space.

After the introduction of the upper part 2 and lower part 3 in this way, the two parts of the intervertebral implant 1 can be spread apart; that is, their spacing is increased, for instance with the aid of the manipulation instrument that is holding the upper 2 and the lower part 3.

In this spread-open position of the upper part 2 and lower part 3, it is possible to thrust the pivot insert 4 between the upper part 2 and the lower part 3.

This pivot insert is constructed essentially in the shape of a plate, which has a flat underside 24 and a spherically upward-curved top side 25. The outer dimensions of the platelike pivot insert correspond to those of the central indentation 19 in the lower part 3, so that the pivot insert 4 can be thrust into this indentation, filling it up, specifically from the side toward which the blind bores 20, 21, 22, 23 open. Guide strips 26 on the side edges of the pivot insert 4 engage corresponding guide grooves 27 in the legs 16, 17, so that an insertion guide for the pivot insert 4 is formed that fixes it in the lower part 3 after its insertion. The inserted pivot insert 4, after insertion, fills up the indentation 19 and protrudes with its spherically curved top side 25 upward past the top side of the lower part 3; the spherical top side 25 dips in complimentary fashion into the spherically curved indentation 12 on the underside of the protrusion 10, where with the upper part 2 it forms a ball joint, which enables a certain pivotability of the upper part 2 relative to the lower part 3 (FIG. 7).

The pivot insert 4 can have a detent protrusion 28 on its flat underside 24; when the pivot insert 4 is inserted into the lower part 3, this protrusion locks elastically into a detent recess 29 that is located on the bottom of the indentation 19; as a result, the pivot insert 4 is also fixed in the insertion direction in the indentation 19.

The upper part 2 and lower part 3 are preferably made of physiologically safe metal, such as titanium, while the pivot insert 4 preferably comprises a likewise physiologically safe plastic material, such as polyethylene. These support faces 5 and 13 can be embodied in an especially bone-compatible way; for instance, this surface can be roughened by a coating, so that optimal anchoring to the adjacent bone material is obtained.

The invention may also be described as follows, which description is the full equivalent of the preceding discussion. An upper part 2 has an upper surface 5 for engaging a vertebrae and a lower surface which comprises a downward pointing protrusion 10 between side recesses 9 and a rounded portion, preferably in the form of a concave spherical indentation 12. A lower part 3 has a lower surface 13 for engaging a vertebrae. A pivot insert 4, when joined to the lower part 3, as shown for example in FIG. 3, provides a convex upper surface portion 25, preferably spherical, in operational engagement with the rounded portion 12 of the upper part.

The lower part 3 and pivot insert 4 may, taken together, be described as a lower part formed in two pieces, namely the elements 3 and 4, wherein the element 3 may be referred to as a lower piece and the element 4 may be referred to as an upper piece.

The upper and lower parts include on their upper surface and lower surface, respectively, protrusions 7 and 14 which may also be referred to as anchors, which anchor the upper and lower parts, respectively, into the adjacent vertebrae that form the intervertebral space and rest against the respective upper and lower surfaces.

As shown in the figures, the anchors 6 and 14 each have a zigzag edge which comprise teeth. As best shown in FIG. 7, anchor 6 is greater in height than the remainder of the upper part 2, i.e., from surface 5 to the bottom of protrusion 10. Similarly, anchor 14 is greater in height than the remainder of the lower part 3, i.e., from lower surface 13 to the top of walls 16, 17 and 18. As also shown in the figures, in the preferred embodiment, the length of the anchors 6 and 14, i.e., in the direction from the anterior to the posterior thereof, is greater than one half of the overall dimension of its respective part from its anterior to its posterior, passing through that anchor.

The lower part comprises three walls including parallel side walls 16 and 17 and a rear wall 18. These walls form between them a central indentation 19 which comprises a recess with a generally flat surface. The fourth side of the recess is open. The pivot insert 4 has a detent 28 that snap-fits into a detent recess 29 formed in the generally flat surface of recess 19.

As best shown in FIGS. 2, 4 and 5, in the absence of pivot insert 4, the protrusion 10 of upper part 2 can fit down between walls 16, 17 and 18 of the lower part 2. This fitting of protrusion 10 within the recess 19, surrounded by walls 16, 17 and 18 may be referred to as “nesting” since the protrusion 10 essentially “nests” within recess 19. With the upper and lower parts in this nested condition, as shown in FIGS. 4 and 5, the combined height of the upper and lower parts 2 and 3, i.e., the height from surface 13 to surface 5, is less than the total additive height of the upper and lower parts, taken separately, i.e., less than the total of the height from surface 13 to the top of walls 16, 17 and 18 plus the height from surface 5 to the bottom of protrusion 10.

To reach its final destination within an intervertebral space, the implant must of course be moved along a path from outside of the patient, into the patient, and then into the intervertebral space. In the illustrated embodiment, as described above, instruments would engage apertures 20, 21, 22 and 23 to move the implant along a path. The anchors 6 and 14 are parallel to this path. As a point of reference, lateral planes parallel to the direction of this path pass through opposed side surfaces of the parts. Thus, in the illustrated embodiment, the path would be parallel to the front to rear (anterior to posterior) direction, wherein, during insertion, the rear (posterior) of the implant would constitute the lead end and the front (anterior) thereof would constitute the trailing end.

Although the invention has been described in detail with respect to preferred embodiments thereof, it will be apparent that the invention is capable of numerous modifications and variations, apparent to those skilled in the art, without departing from the spirit and scope of the invention. 

The invention claimed is:
 1. An intervertebral implant configured to be inserted into an intervertebral space between adjacent first and second vertebrae and having a lead end that leads as the implant is inserted in an insertion direction into the intervertebral space and a trailing end opposite the lead end, the intervertebral implant comprising: a first part having an outer surface for engaging the first vertebrae and having an inner surface comprising a downward-pointing protrusion and a concave portion; a second part having an outer surface for engaging the second vertebrae, an inner surface comprising a recess with an opening located on the trailing end of the second part, and opposing side walls located adjacent the recess and extending transversely from the trailing end; an insert having a first surface configured to engage the inner surface of the first part and a convex portion to mate with the concave portion of the first part, and a second surface engaging the inner surface of the second part; and one of the inner surface of the second part and the second surface of the insert including an elongated detent recess extending thereacross, and another of the inner surface of the second part and the second surface of the insert having an elongated detent, which detent is resiliently engageable in the detent recess as the insert is inserted onto the inner surface of the second part; wherein the protrusion of the first part and each of the opposing side walls of the second part comprise a bore for accepting an insertion instrument.
 2. An intervertebral implant according to claim 1, wherein the first part has a vertical height and the second part has a vertical height, and wherein the protrusion of the first part is nestable within the recess of the second part in the absence of the insert such that when the first part is nested with the second part a total vertical height of the first and second parts is less than a combined vertical height of the first and second parts separately.
 3. An intervertebral implant according to claim 2, said detent recess extending across the inner surface of the second part perpendicular to the side walls, and the elongated detent located on the insert and also extending perpendicular to the side walls so as to engage the detent recess in the second part.
 4. An intervertebral implant according to claim 2, wherein the recess of the second part is bounded by the opposing side walls of the second part and a back wall perpendicular to the opposing side walls.
 5. An intervertebral implant according to claim 2, wherein the bores of the protrusion of the first part and the opposing side walls of the second part overlap at least partially in a direction of the vertical height of the first and second parts when the first and second parts are brought together such that the protrusion of the first part nests within the recess of the second part.
 6. An intervertebral implant configured to be inserted into an intervertebral space between adjacent first and second vertebrae and having a lead end that leads as the implant is inserted in an insertion direction into the intervertebral space and a trailing end opposite the lead end, the intervertebral implant comprising: a first part having an outer surface for engaging the first vertebrae and having an opposing inner surface comprising a downward-pointing protrusion and a concave portion which is curved inward toward the outer surface of the first part, a second part having an outer surface for engaging the second vertebrae and an opposing inner surface comprising a recess with an opening located on the trailing end of the second part, the recess bounded by two opposed side walls extending transversely from the trailing end to the lead end, each side wall having a guide groove; and an insert having a first surface engaging the inner surface of the first part and a convex portion which extends toward the outer surface of the first part, to mate with the concave portion of the first part, and a second surface configured to engage the inner surface of the second part, the insert having opposed transverse sides, each side having a guide strip to engage a respective one of the guide grooves of the second part; one of the inner surface of the second part and the second surface of the insert including an elongated detent recess extending thereacross, and another of the inner surface of the second part and the second surface of the insert having an elongated detent, which detent is resiliently engageable in the detent recess as the insert is inserted onto the inner surface of the second part.
 7. The intervertebral implant of claim 6, wherein the protrusion of the first part and the opposed side walls of the second part each comprise a bore to receive an insertion instrument.
 8. An intervertebral implant configured to be inserted into an intervertebral space between adjacent first and second vertebrae and having a lead end which leads as the implant is inserted in an insertion direction into the intervertebral space and a trailing end opposite the lead end, the intervertebral implant comprising: a first part which has an outer surface defining a first part support face for engaging the first vertebrae and an opposite facing inner surface which has a downward-pointing protrusion and a curved inner surface, which is concave inward toward the outer surface of the first part; a second part which has an outer surface defining a second part support face for engaging the second vertebrae and an opposite facing inner surface having a recess with an opening located on the trailing end of the second part, the support faces of the first and second parts being substantially parallel to each other; and an insert having a base portion which is shaped to enter the recess through the opening of the second part to be engaged in said recess, the insert including a raised upwardly extending convex portion which is smaller in area, transversely, than the base portion and which extends upwardly from the base portion and which is configured to mate with the curved inner surface of the first part to allow relative movement of the first part and the second part, wherein the protrusion of the first part is nestable within the recess of the second part in an insertion position such that when the first part is nested with the second part a total height of the first and second parts is less than an additive total height of the first and second parts separately; and wherein the lead end is located between the outer surface of the first part and the outer surface of the second part; wherein the first part and the second part have, on the trailing end between the support faces of the first and second parts, an engagement mechanism for engaging an instrument for insertion of the first and second parts into the intervertebral space; and wherein the inner surface of the second part comprises a pair of opposed side walls bounding said recess therebetween, and the opening is located between said opposed side walls and wherein said recess includes a generally flat surface bounded by the opposed side walls and an end wall located at an end opposite from said opening.
 9. An intervertebral implant according to claim 8, wherein the curved inner surface and convex portion are spherical.
 10. An intervertebral implant according to claim 9, wherein the opposed sidewalls of the second part and the base portion of the insert comprise interengaging flange and groove connections.
 11. An intervertebral implant according to claim 9, wherein the protrusion of the first part has opposing first and second side recesses extending transversely from the trailing end toward the lead end that are designed to nest with the opposed side walls of the second part.
 12. An intervertebral implant according to claim 8, wherein the engagement mechanism comprises a pair of apertures.
 13. An intervertebral implant according to claim 8, the first and second parts being generally rectangular.
 14. An intervertebral implant configured to be inserted into an intervertebral space between adjacent first and second vertebrae, the intervertebral implant having a height extending in a first direction, a width extending in a second direction, and a depth extending in a third direction, where the first, second, and third directions are each perpendicular to each other, the implant having a maximum width greater than an implant maximum depth, and having a lead end that leads as the implant is inserted in an insertion direction into the intervertebral space and a trailing end opposite the lead end along the insertion direction, the intervertebral implant comprising: a first part having an outer surface defining a first part support face for engaging the first vertebrae and having an inner surface having a downwardly extending protrusion and a concave portion which is curved inward toward the outer surface of the first part, a second part having an outer surface defining a second part support face for engaging the second vertebrae and an inner surface comprising a recess partially bounded by two opposed side walls extending transversely from the trailing end and a back wall extending between the two opposed side walls, the recess having an opening located on the trailing end and the support faces of the first and second parts being substantially parallel to each other; wherein the protrusion of the first part is nestable in the recess of the second part for insertion of the first and second parts together into the intervertebral space; and an insert having a base sized to enter the opening to the recess of the second part and a top surface comprising an upwardly extending, toward the outer surface of the first part, convex spherical portion configured to operatively engage the concave portion of the inner surface of the first part such that the first part can pivot upon the insert in each of the first, second, and third directions; wherein the lead end is located between the outer surface of the first part and the outer surface of the second part; and wherein each of the first part and the second part comprises, on the trailing end between the support surfaces of the first and second parts, an engagement mechanism for engaging with an instrument for inserting the first and second parts into the intervertebral space.
 15. The intervertebral implant according to claim 14, wherein the engagement mechanism comprises a pair of apertures.
 16. The intervertebral implant according to claim 14, wherein the engagement mechanism comprises a bore located within the protrusion of the first part and a bore located within each of the side walls of the second part.
 17. The intervertebral implant according to claim 16 wherein the implant has a vertical height and when the protrusion of the first part is nested in the recess of the second part the bores of the side walls and protrusion at least partially overlap in a direction of the vertical height of the implant.
 18. The intervertebral implant according to claim 17 wherein the side walls of the second part have grooves extending transversely from the opening and the base of the insert has guide strips along opposed transverse sides of the base to engage the grooves in the side walls of the second part.
 19. The intervertebral implant of claim 17 wherein the bores of the protrusion and the side walls of the second part extend in parallel.
 20. The intervertebral implant of claim 19 wherein the first and second parts are generally rectangular.
 21. An intervertebral implant sized and configured to replace a natural disk removed from an intervertebral space between opposing end faces of a first vertebra and an adjacent second vertebra, the intervertebral implant having a height extending in a first direction, a width extending in a second direction, and a depth extending in a third direction, where the first, second, and third directions are each perpendicular to each other, the implant having a maximum width greater than an implant maximum depth, the implant comprising: a first part having an outer surface facing substantially in the first direction and configured to rest against the end face of the first vertebrae and having an inner surface facing substantially opposite the outer surface, the inner surface comprising a concave portion; a second part having an outer surface facing substantially opposite the outer surface of the first part and configured to rest against the end face of the second vertebrae and an opposing inner surface facing substantially in the first direction; a pivot insert located between the first part and the second part and having an upper surface facing substantially in the first direction, a lower surface that faces opposite the upper surface of the insert, and a sidewall that extends circumferentially around the pivot insert, the sidewall connecting the upper and lower surfaces of the pivot insert, the pivot insert including a spherical, convex portion on the upper surface configured to operatively engage the concave portion of the first part where the spherical, convex portion is smaller in area, transversely, than the upper surface of the insert; and a first anchor located on the outer surface of the first part, the first anchor having a height extending in the first direction, a width extending in the second direction, and a depth extending in the third direction, wherein the first anchor has a first anchor base connecting the first anchor to the outer surface of the first part and wherein the first anchor base has a first base depth that extends depthwise substantially along a first midline that extends in the third direction and that is located essentially midway across the width of the outer surface of the first part, and a first base width that extends in the second direction and is less than the first base depth, where the first anchor has a first center height measured from the outer surface of the first part at a first center position located at approximately a center of the first midline and the first anchor has a mid-anchor width measured at a location half of the first center height and wherein the first center height is greater than the mid-anchor width of the first anchor, and the first base depth is greater than the mid-anchor width of the first anchor, and wherein the first anchor has a first anchor top opposite the first anchor base having a first top width less than the first base width; a second anchor located on the outer surface of the second part, the second anchor having a height extending in the first direction, a width extending in the second direction, and a depth extending in the third direction, wherein the second anchor has a second anchor base connecting the second anchor to the outer surface of the second part and wherein the second anchor base has a second base depth that extends depthwise substantially along a second midline that extends in the third direction and that is located essentially midway across the width of the outer surface of the second part, and a second base width that extends in the second direction and is less than the second base depth, where the second anchor has a second center height measured from the outer surface of the second part at a second center position located at approximately a center of the second midline and the second anchor has a mid-anchor width measured at a location half of the second center height and wherein the second center height is greater than the mid-anchor width of the second anchor, and the second base depth is greater than the mid-anchor width of the second anchor, and wherein the second anchor has a second anchor top opposite the second anchor base having a second top width less than the second base width; wherein the first center height is greater than a height of a remainder of the first part measured from the outer surface to the inner surface of the first part at the first center position; and wherein the first midline is the only location on the outer surface of the first part having an anchor having a height equating to the first center height.
 22. The intervertebral implant of claim 21 wherein the second part comprises a recess on the inner surface of the second part, and the insert comprises a protrusion extending from the lower surface of the insert configured to engage the recess of the second part.
 23. The intervertebral implant of claim 22 wherein the outer surfaces of the first and second parts comprise a roughened coating.
 24. The intervertebral implant of claim 21 wherein the upper surface of the insert further comprises a substantially flat portion facing substantially in the first direction and bounded by the sidewall and the spherical convex portion of the insert.
 25. The intervertebral implant of claim 24 wherein the second part comprises a recess on the inner surface of the second part, and the insert comprises a protrusion extending from the lower surface of the insert configured to engage the recess of the second part.
 26. The intervertebral implant of claim 25 wherein the recess of the second part is bounded in part by a first sidewall and a second sidewall, the first sidewall having a first inner side surface having a length in the third direction and a height in the first direction and the second sidewall having a second inner side surface having a length in the third direction and a height in the first direction where the length of the first inner side surface is greater than the height of the first inner side surface, and the length of the second inner side surface is greater than the height of the second inner side surface, and where the spherical, convex portion has a depth and the first inner side surface extends parallel to the second inner side surface in the third direction for a distance greater than the depth of the spherical, convex portion.
 27. The intervertebral implant of claim 21 wherein the outer surfaces of the first and second parts comprise a roughened coating.
 28. An assemblage of related components comprising a first part, a second part, and a pivot insert that are each sized to form, when assembled, an intervertebral implant sized and configured to replace a natural disk removed from an intervertebral space between opposing end faces of a first vertebra and an adjacent second vertebra, the intervertebral implant having a height extending in a first direction, a width extending in a second direction, and a depth extending in a third direction, where the first, second, and third directions are each perpendicular to each other, the implant having a maximum width greater than an implant maximum depth, the assemblage comprising: the first part including an outer surface facing substantially in the first direction and configured to rest against the end face of the first vertebrae and having an inner surface facing substantially opposite the outer surface, the inner surface comprising a concave portion; the second part including an outer surface facing substantially opposite the outer surface of the first part and configured to rest against the end face of the second vertebrae and an opposing inner surface facing substantially in the first direction; the pivot insert configured to be located between the first part and the second part and having an upper surface facing substantially in the first direction, a lower surface that faces opposite the upper surface of the pivot insert, and a sidewall that extends circumferentially around the pivot insert connecting the upper and lower surfaces of the pivot insert, the pivot insert including a spherical, convex portion on the upper surface configured to operatively engage the concave portion of the first part where the spherical, convex portion is smaller in area, transversely, than the upper surface of the pivot insert; and wherein the first part further comprises a first anchor located on the outer surface of the first part and having a height extending in the first direction, a width extending in the second direction, and a depth extending in the third direction, wherein the first anchor has a first base connecting the first anchor to the outer surface of the first part and wherein the first base has a first base depth that extends depthwise substantially along a first midline that extends in the third direction and that is located essentially midway across the width of the outer surface of the first part, and a first base width that extends in the second direction and is less than the first base depth, where the first anchor has a first center height measured from the outer surface of the first part at a first center position located at approximately a center of the first midline and the first anchor has a mid-anchor width measured at a location half of the first center height and wherein the first center height is greater than the mid-anchor width of the first anchor, and the first base depth is greater than the mid-anchor width of the first anchor, and wherein the first anchor has a first anchor top opposite the first anchor base having a first top width less than the first base width; wherein the second part further comprises a second anchor located on the outer surface of the second part and having a height extending in the first direction, a width extending in the second direction, and a depth extending in the third direction, wherein the second anchor has a second base connecting the second anchor to the outer surface of the second part and wherein the second base has a second base depth that extends depthwise substantially along a second midline that extends in the third direction and that is located essentially midway across the width of the outer surface of the second part, and a second base width that extends in the second direction and is less than the second base depth, where the second anchor has a second center height measured from the outer surface of the second part at a second center position located at approximately a center of the second midline and the second anchor has a mid-anchor width measured at a location half of the second center height and wherein the second center height is greater than the mid-anchor width of the second anchor, and the second base depth is greater than the mid-anchor width of the second anchor, and wherein the second anchor has a second anchor top opposite the second anchor base having a second top width less than the second base width; wherein the first center height is greater than a height of a remainder of the first part measured from the outer surface of the first part to the inner surface of the first part at the first center position; and wherein the first midline is the only location on the outer surface of the first part having an anchor having a height equating to the first center height.
 29. The assemblage of claim 28 wherein the second part comprises a recess on the inner surface of the second part, and the insert comprises a protrusion extending from the lower surface of the insert configured to engage the recess of the second part.
 30. The assemblage of claim 29 wherein the outer surfaces of the first and second parts comprise a roughened coating.
 31. The assemblage of claim 28 wherein the upper surface of the insert further comprises a substantially flat portion facing in the first direction and bounded by the sidewall and the spherical, convex portion.
 32. The assemblage of claim 31 wherein the second part comprises a recess on the inner surface of the second part, and the insert comprises a protrusion extending from the lower surface of the insert configured to engage the recess of the second part.
 33. The assemblage of claim 32 wherein the recess of the second part is bounded in part by a first sidewall and a second sidewall, the first sidewall having a first inner side surface having a length in the third direction and a height in the first direction and the second sidewall having a second inner side surface having a length in the third direction and a height in the first direction, where the length of the first inner side surface is greater than the height of the first inner side surface, and the length of the second inner side surface is greater than the height of the second inner side surface, and where the first inner side surface extends parallel to the second inner side surface in the third direction.
 34. The assemblage of claim 33 wherein the outer surfaces of the first and second parts comprise a roughened coating. 